PTH-008 Safety And Efficacy Of Balloon Sphincteroplasty Using Controlled Radial Expansion (cre) Balloon During Endoscopic Retrograde Cholangio Pancreatography In The Management Of Large Common Bile Duct (cbd) Stones: A District General Hospital Experience

Abstract Aim Common bile duct (CBD) stones are the most common cause of obstructive jaundice. Laparoscopic exploration of the CBD with laparoscopic cholecystectomy has been preferred to endoscopic treatment, as a single-stage modality of treatment for CBD stones. This procedure was started in a District General Hospital in May 2019 using the standard port sites and Ambu® aScope™ 2 single-use flexible scope. Methods Retrospective analysis of outcome of all laparoscopic CBD explorations done in a District General Hospital between May 2019 and September 2020. Results A total of ten laparoscopic CBD explorations were carried out during the identified period, the main indications were young patients (40%), referral by gastroenterologist (40%) and failed endoscopic retrograde cholangiopancreatography (ERCP) (20%). The mean age (±SD) was 54.7 (± 19.2) and 70% of patients were females. Two thirds of the operations were done in emergency setting, with choledochotomy approach being used in 60% of cases and primary closure in all cases. The average length of stay (±SD) after the operation was 3.1 (±1.9). Only one patient developed a haemoserous collection that required a laparoscopic washout, none of the patients required readmission. Conclusion Laparoscopic CBD exploration can be performed safely in a district general hospital, the disposable Ambu® aScope™ 2 is safe, feasible and cost-effective substitute to the reusable choledochoscope. Provision of this laparoscopic CBD exploration at district general hospital level is more convenient to patients and can reduce referrals to regional hepatobiliary units, and therefore provide a good training opportunity for surgical registrars in this setting.

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O-L03 Safety and Efficacy of Endoscopic Retrograde Cholangiopancreatography for Removal of Common Bile Duct Stones in the Nonagenarians: A Single Tertiary Centre Experience

British Journal of Surgery ◽

10.1093/bjs/znab429.026 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Sijjad Ijaz ◽

Amaan Khan ◽

Mohammed Gariballa ◽

Mustafa Jalal ◽

Yasser Amer Al-Joudeh

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Statistical Significance ◽

Anticoagulation Therapy ◽

Endoscopic Retrograde ◽

Safety And Efficacy ◽

Cbd Stones ◽

Group A ◽

Group B

Abstract Background It is estimated that one in four persons in the UK will be > 65 years old by 2050. Endoscopic retrograde cholangiopancreatography (ERCP) is the recommended therapy for removals of common bile duct (CBD) stones. There is a lack of UK data on the outcome of ERCP in the very elderly. We aimed to investigate the safety and efficacy of ERCP in the management of CBD stones in the elderly >90 years old compared with those aged 65-89 years old. Methods We retrospectively analysed patients undergone ERCP between 2016-2020. Those with conditions other than suspected CBD stones were excluded. The following data was collected: general demographics, comorbidities, American Association of Anaesthesiology (ASA) grading, presence of dementia, anticoagulation therapy, endoscopic report on completed intention of treatment which is defined by either removal of stone and/or stent insertion. Also, post-procedure complications were collected including post-ERCP pancreatitis (PEP), bleeding, perforation, cholangitis, respiratory, and cardiovascular (CVS) events. Readmission within 7 days and death within 30 days were collected. Outcomes were reported as mean ± (SD) or n (%). Statistical significance was considered when P < 0.05. Results Total, 126 patients ≥ 90 years(group A) compared to 262 patients aged 65-89 years(group B). Higher rate of dementia, and anticoagulation therapy in Group A (17.4%) vs (0.4%),p <0.0001 and (36.5%) vs (17.9%),p <0.0001,respectively. Completed treatment was achieved in group A(90.5%) compared to group B(89.9%),p 0.7. One patient (0.8%) had PEP group A compared to 8(3.1%) group B,p 0.3. Overall complications (13.5%) group A vs (9.5%) group B,p 0.3. Four cases (3.2%) died within 30-day in group A compared to group B 5 (1.9%), p 0.5. There was no procedure-related death Conclusions ERCP for removal of CBD stones in > 90 years old is effective. Risk of post-ERCP pancreatitis and overall adverse events were not higher in the > 90 years compared to 65-89 years old. We report a 30-day mortality rate of 3.2%. The most common cause of death was pneumonia including COVID-19 peumonia.

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Surgical procedure for unexpected balloon burst complication during endoscopic balloon dilatation in a patient with common bile duct stones

Surgical Case Reports ◽

10.1186/s40792-020-01014-5 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Koji Morishita ◽

Hideaki Sasaki

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Balloon Dilatation ◽

Rare Complication ◽

Common Bile Duct Stones ◽

Endoscopic Retrograde ◽

Case Presentation ◽

Endoscopic Balloon Dilatation ◽

Cbd Stones ◽

Endoscopic Balloon

Abstract Background Endoscopic balloon dilatation (EBD) is the established treatment for common bile duct (CBD) stones. Although pancreatitis and bleeding have been reported as major complications of EBD, balloon-related complications are rarely reported in EBD. Case presentation A 30-year-old woman with suspected CBD stones underwent endoscopic retrograde cholangiopancreatography (ERCP) and EBD. During EBD, the balloon of the EBD catheter suddenly burst at the biliary sphincter. We therefore performed surgical intervention: removal of the broken EBD catheter and T-tube drainage. Finally, the patient was discharged without any complications. Conclusions We present a case involving a burst balloon of an EBD catheter as a rare complication during EBD, as well as the surgical technique that was used to treat this complication.

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PTH-127 Appropriateness of use of MRCP (Magnetic Resonance Cholangio-Pancreaticgraphy) in Patients with Suspected CBD Stones – a District General Hospital Experience

Gut ◽

10.1136/gutjnl-2013-304907.614 ◽

2013 ◽

Vol 62 (Suppl 1) ◽

pp. A262.3-A263

Author(s):

A Uppal ◽

S Latif ◽

G Sheiybani ◽

S Shetty

Keyword(s):

Magnetic Resonance ◽

General Hospital ◽

District General Hospital ◽

Cbd Stones ◽

Hospital Experience

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Safety and efficacy of endoscopic retrograde cholangiopancreatography for common bile duct stones in liver cirrhotic patients

Journal of Huazhong University of Science and Technology [Medical Sciences] ◽

10.1007/s11596-014-1325-x ◽

2014 ◽

Vol 34 (4) ◽

pp. 612-615 ◽

Cited By ~ 13

Author(s):

De-min Li ◽

Jie Zhao ◽

Qiu Zhao ◽

Hua Qin ◽

Bo Wang ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Common Bile Duct Stones ◽

Bile Duct Stones ◽

Endoscopic Retrograde ◽

Safety And Efficacy ◽

Cirrhotic Patients

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Total Bilirubin is a Useful Predictor of Persisting Common Bile Duct Stone in Gallstone Pancreatitis

The American Surgeon ◽

10.1177/000313480807401020 ◽

2008 ◽

Vol 74 (10) ◽

pp. 977-980 ◽

Cited By ~ 8

Author(s):

Tony Chan ◽

Arezou Yaghoubian ◽

David Rosing ◽

Edward Lee ◽

Roger J. Lewis ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Total Bilirubin ◽

Bile Duct Stone ◽

Total Bilirubin Level ◽

Serum Total Bilirubin ◽

Gallstone Pancreatitis ◽

Endoscopic Retrograde ◽

Cbd Stones ◽

Unnecessary Procedures

Accepted guidelines for preoperative endoscopic retrograde cholangiopancreatography (ERCP) in gallstone pancreatitis are lacking. Our previous investigations suggested that serum total bilirubin on hospital Day 2 best predicts persisting common bile duct (CBD) stones. We aim to identify an optimal total bilirubin threshold on hospital Day 2 that would predict persisting CBD stones and guide obtaining preoperative ERCP. Prospective and retrospective data were available from 200 consecutive patients with gallstone pancreatitis at a public teaching hospital from 2003 through 2007. Charts were examined for persisting CBD stones on ERCP and/or intraoperative cholangiography during laparoscopic cholecystectomy. Patients with cholangitis (n = 18) were excluded. Nineteen of the remaining 182 (10%) patients had CBD stones. Mean hospital Day 2 bilirubin was 3.7 mg/dL for patients with CBD stones versus 1.4 mg/dL for those without (P < 0.0001). Seventeen patients (9%) had total bilirubin 4 or greater on hospital Day 2. Of these, eight (4%) had CBD stones (specificity 94%). Of the 165 patients with total bilirubin less than 4, 11 (7%) had CBD stones (P < 0.0001). In gallstone pancreatitis, a serum total bilirubin level 4 mg/dL or greater on hospital Day 2 predicts persisting CBD stones with enough specificity to serve as a practical guideline for ERCP while minimizing unnecessary procedures.

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